A bit of problem. Any advice or reassurance

[SB2015]

I am in my last two days of a long holiday in Canada. In the last three days I have woken in the night with ketones. Last night was the worst and I felt rough but upped the TBR and correction and back on track in the morning.

There are a lot of factors to manage and I feel that I am fire fighting. Worried about getting ketones so often. I am assuming that so long as I do not start to feel drowsy, vomit, wheeze I am safe just firefighting and doing the best I can. It is night time that is the worst as I am worried that I will Hypo if TBR is too much. At present I am waking every two hours to check. Better to be tired than end up with kidney infection from UTI, although the infection is going to be thriving with so many mountainous BGs.

Possible causes
- I am currently taking antibiotics for a urine infection (so BG will be up due to that)
- I am not able to prebolus for meals as I have no idea when they will be in front of me
- We have now been away for over thirty days, and I have kept my insulin as cool as possible, but perhaps it is now less active.

I have learnt to react and just up the insulin, but at present I am running a TBR of 200%.
Then I am trying to factor other things in
I normally
- increase basal rate for sitting and travelling (140%)
- decrease basal rate for active day and we are out and about but it is unpredictable (50% for a hike)
- prebolus for all meals, but we are eating out all the time
- ...

Any ideas welcome

 

[Northerner]

What levels are the ketones at when you measure them and what are your blood sugar levels at the time? You might find a small carby snack sufficient to lower them - I discovered this once when very ill. I was using insulin, BG levels around 9-14, but ketones would decrease with a small snack as the body has more glucose to feed off 🙂

You might find this guide helpful (for MDI but the principles apply)

http://www.uclh.nhs.uk/PandV/PIL/Patient information leaflets/Sick day rules – multiple daily injections.pdf

Hope you are feeling better soon 🙂

 

[Pumper_Sue]

- I am not able to prebolus for meals as I have no idea when they will be in front of me

Would it be possible to either do small bolus before the meal then add the rest in once you know what's on your plate?
Or
other option would be to decide you are going to eat X amount of carbs and stick to that.

Or would you be comfy in turning off your basal if you bolus all up front if you find you have over bloused?

 

[Pigeon]

I also had the same thing happen in Canada! I was on MDI then though so less flexible. I woke up every morning at 15mmol, felt terrible! I put it down to the changing time zone (I kept my lantus at the same UK time, but maybe the peaks didn't fit as well with my day being shifted). Have you changed the clock on your pump? Maybe your body's not quite on Canadian time yet??

Also massive portion sizes, and unfamilar foods! Some things that didn't digest for hours, way into the night, and a lot more meat than I normally ate. Gary Scheiner suggests a 150% TBR for 8 hours after a large, fatty meal, maybe try that? I have done it once or twice after BBQs etc and whilst scary, it does seem to work. Having said that I am quite happy waking and treating nighttime hypos, so don't worry too much about these, but if you do I can understand you being more cautious. Like pumper Sue, I would probably bolus eg for 50g carbs up front and if the meal is delayed have ajuice or something rather than wait until it's in front of me. Then you can always top up later or have pudding if you injected too much!

Hope it doesn't spoil your trip, it's a fab country!

 

[SB2015]

That’s what is so good about this forum. OH suggested posting, and look what happens.
Three useful ideas, which will help me manage better on these last few days.
Thank you.

I was delighted today to hit 4.2 at my pre lunch today.Bliss.
And ...
- the antibiotics seem to be sorting out the UTI finally
- my TBR of 200% is working and I am doubling my bolus as well
(I suspect the problem is the insulin being less effective)

 

[SB2015]

What levels are the ketones at when you measure them and what are your blood sugar levels at the time? You might find a small carby snack sufficient to lower them - I discovered this once when very ill. I was using insulin, BG levels around 9-14, but ketones would decrease with a small snack as the body has more glucose to feed off 🙂

You might find this guide helpful (for MDI but the principles apply)

http://www.uclh.nhs.uk/PandV/PIL/Patient information leaflets/Sick day rules – multiple daily injections.pdf

Hope you are feeling better soon 🙂

Thanks Northerner

It never occurred to me to eat to reduce the ketones.
I felt so rough yesterday and particularly last night that I couldn’t imagine eating anything.
I nibbled one biscuit, but that may we’ll have contributed to the problem.
I shall add that to my Hyper flowchart.

 

[SB2015]

Would it be possible to either do small bolus before the meal then add the rest in once you know what's on your plate?
Or
other option would be to decide you are going to eat X amount of carbs and stick to that.

Or would you be comfy in turning off your basal if you bolus all up front if you find you have over bloused?

Thanks Sue
I have been blousing for an amount when we arrive at the restaurant, then oredering a drink if needed. We had to wait one hour in one restaurant from ordering. That proved very irritating.

I tried eating to my usual 30g of cabs, but I found that difficult. Having said that in the past two days I have managed to get about 10g of carbs down me. Which I now realise will have just added to the problem.

I have never heard of turning off the basal to counter an over estimate on bolus. That makes sense as well.[/QUOTE]

 

[SB2015]

I also had the same thing happen in Canada! I was on MDI then though so less flexible. I woke up every morning at 15mmol, felt terrible! I put it down to the changing time zone (I kept my lantus at the same UK time, but maybe the peaks didn't fit as well with my day being shifted). Have you changed the clock on your pump? Maybe your body's not quite on Canadian time yet??

Also massive portion sizes, and unfamilar foods! Some things that didn't digest for hours, way into the night, and a lot more meat than I normally ate. Gary Scheiner suggests a 150% TBR for 8 hours after a large, fatty meal, maybe try that? I have done it once or twice after BBQs etc and whilst scary, it does seem to work. Having said that I am quite happy waking and treating nighttime hypos, so don't worry too much about these, but if you do I can understand you being more cautious. Like pumper Sue, I would probably bolus eg for 50g carbs up front and if the meal is delayed have ajuice or something rather than wait until it's in front of me. Then you can always top up later or have pudding if you injected too much!

Hope it doesn't spoil your trip, it's a fab country!

Thanks Pigeon

We usually share a meal, or just order starters to deal with the portion sizes, but they are still big, and my will power is not good. I have managed for four weeks with more ups and downs than I would normally at home, but the past three nights have been awful. I too wake up with night hypos so I would rather get things lower if possible. I had forgotten about using a multiwave for more than 50g of carbs, and will try the TBR if the meal is particularly fatty.

Useful ideas for our last few days and also for eating at friends when it is harder to control portion sizes.

Thanks again

 

[HOBIE]

Air travel always unsettles you. Keep hydrated & get some vit C. Enjoy if you can 🙂

 

[everydayupsanddowns]

Glad you had some great suggestions.

I find the partial pre-bolus a v useful strategy (especially if there are nibbles around enough if the meal is majorly delayed). Fully pre-bolusing when eating out rarely works well for me and is quite stressful.

Hope your BGs have turned a cooperative corner.